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Blockade of transdiaphragmatic lymphatic absorption reduced systemic inflammatory response syndrome during
E Gürleyik1, G Gürleyik, S Unalmişer
1Department of Surgery, Haydarpasa Numune Hospital, Istanbul, Turkey.
Objective:
To assess the effect of blockade of transdiaphragmatic lymphatic absorption of infected peritoneal fluid on systemic inflammatory response syndrome during experimental peritonitis by evaluating body oxygen kinetics in rats.
Design:
Randomised controlled experimental study.
Setting:
Teaching hospital, Turkey.
Material:
30 Wistar-albino rats, 10 in each group.
Interventions:
Control group, sham laparotomy; peritonitis alone group, faecal peritonitis induced by caecal puncture; and lymphatic blockade and peritonitis group, transdiaphragmatic lymphatic absorption was blocked by fibrosis created by a sheet of braided polyester (Mersilene) mesh, and peritonitis induced with caecal puncture.
Main Outcome Measures:
Aerobic culture of peritoneal contents and blood. Arterial and mixed venous blood gas analysis, plasma lactate concentrations. Indicators of body oxygen kinetics were calculated from these variables.
Results:
Bacterial peritonitis was detectable in all 20 animals in the experimental groups. Blood cultures grew pathogens in 9/10 animals in the peritonitis alone group and 4/10 in the lymphatic blockade group (p = 0.057). Among the measured blood gas variables there were significant differences in PvO2 (p = 0.006) and in PaCO2 (p = 0.02), and as indicators of tissue perfusion and acidosis there were significant differences in all calculated blood gas variables and in plasma lactate concentration (p = 0.0001) between the two experimental groups. Hypoxia as judged by the oxygen utilisation coefficient of over 0.5 and oxygen saturation of mixed venous blood of less than 50%, eight animals were hypoxic in the peritonitis alone group compared with one in the lymphatic blockade group (p = 0.006).
Conclusion:
Animals in which transdiaphragmatic drainage was obstructed had fewer positive blood cultures and better body oxygen balance during peritonitis, indicating that blockade of transdiaphragmatic lymphatic absorption of peritoneal contents reduced systemic inflammatory response syndrome.